John Lahart (Dublin South West, Fianna Fail) | Oireachtas source

I am delighted to be able to contribute to this debate. I know how earnestly Deputy Finian McGrath views this topic as the Minister of State at the Department of Health with special responsibility for disabilities. The Department has a budget and he has to try to shoehorn as many things as he can into that budget but our job as Opposition spokespeople is to hold him to account in this particular position.

I will make a number of general points on primary care. One of the major health insurers operates what is known as Swiftcare, which has turned out to be a successful model in saving emergency departments in a number of Dublin hospitals in particular, and perhaps in other parts of the country, from even more overcrowding than they have because they are able to deal with injuries and issues that people often attend emergency departments with. There was a cost for people who attended that but one could essentially be dealt with pretty expeditiously and certainly within an hour in most cases, which would be unheard of in an emergency department or emergency room, ER, setting. The problem is that the health insurer has confined that facility to its policyholders.

In the context of locating primary care centres in as many areas as possible, which I know is the ambition under the primary care strategy, there should be a Swiftcare dimension to this where minor traumas such as ankle twists could be treated. VHI policyholders can go to Swiftcare in Dundrum if their kids have been injured in a football game on Saturday afternoon or Sunday afternoon and it is full with them at those times. They do not end up waiting long periods in emergency departments dealing with minor traumas that could be dealt with in the community. That is a model that needs to be looked at.

I refer to my experience as a public representative that goes back 20 years. In the original local authority area that I represented for many years, which covered Rathfarnham, Templeogue and Knocklyon, the HSE made five or six valiant efforts by to deliver primary care facilities. It turned out that the least difficult challenge was securing planning from the local authority. Some of the difficulties arose with attracting GPs to serve in the primary care centre when it was built.

There was to be one in a particular locality close to me in Rathfarnham village. Planning permission was granted and a lot of work had been done by the HSE to secure the medical personnel who were key to the success of that primary care centre if it took off. When planning permission was granted and the project started to move forward apace, it is my understanding that the GPs withdrew for various different reasons. I am sure they were some good reasons and the building became a preschool Montessori building and, therefore, Rathfarnham has no primary care centre. There is a site at St. Augustine's in Ballyboden. The primary care centre project has been going on there for eight or nine years at this stage and according to the latest parliamentary question responses I have received, it looks like we are looking at a public private partnership, PPP, leaseback arrangement between the HSE and some developer if it can get developers interested in the project because the HSE cannot afford to build the primary care centre.

Elections are a good way of testing the pulse of people. I often tell colleagues that in 2009 two issues simply were not emerging on the doors when I was canvassing in the local elections but by 2014 they had begun to spring up and have been growing exponentially. One was autism, which featured to some degree on the doors in 2009 but since the 2014 local election campaign and up to now, one cannot go through a housing estate without meeting multiple examples of families concerned about autism and the spectrum of children with special needs and the need for their diagnosis. This simply did not feature a decade ago. The other issue is dementia. Dementia did not feature as a need ten years ago when I knocked on doors. Professor Rónán Collins in University Hospital Tallaght has stated we need to prepare for a 20% dementia society.

The Minister of State gets this but I must hold him to account for this and there is nothing more heartbreaking than meeting parents of children, whom they suspect have a special need, who need an assessment, who are going through the most vital development needs of their lives, physically, mentally and psychologically and who are on waiting lists for psychological assessment. Some of the local centres are full and the lists are full but let us use the NTPF and give these parents a voucher in order that they can have the psychological assessment done privately by an approved HSE psychologist. This would mean that they could begin to make preparations for their children and do what is necessary to ensure their children get the help that they need at the earliest stage possible and the interventions that could make that critical difference to their development, educational development and, ultimately, educational attainment.

The same can be said for speech and language therapy and the Minister of State will have heard about if he was out and about during the recent local election campaign. These vital interventions are required at the most vital developmental stages of a child's life. The Minister of State will come back and say he has addressed this but I need to hold him to account on behalf of my constituents. He is in government and in charge of the spread of resources. There is nothing more heartbreaking than meeting parents at clinics who know that their child has a need, whose teachers have concerns, even in preschool stages, and they cannot get access to speech and language assessments or services because there simply are none. The cost to the State of providing something such as a voucher system for these parents that would enable them to secure speech and language assistance privately would be minuscule because a large number of speech and language therapy professionals are available in the private sector. As we speak the clock is ticking on so many of these children.

Home care packages make such a difference, which colleagues which pointed out earlier. Deputy O'Dea introduced a Bill last year in that regard. It essentially provided for a fair deal at home scheme and, according to his costings, it would save the State 66% on each package. Most families I encounter want to mind and care for their loved ones in the family home for as long as they can. He estimated that the cost of a fair deal at home scheme would be one third of the cost of the existing fair deal scheme with all its complications where properties are left unoccupied in Dublin, in particular because of the sensitivities associated with selling a family property where a loved one is still alive who probably cherishes the possibility of returning home at some stage.

There is much to consider in respect of primary care. I welcome the centres that have been rolled out in Tallaght and that form part of a campus in close proximity to the university hospital. In burgeoning areas such as CityWest, however, where a massive amount of development has been undertaken, or Ballycullen, Knocklyon, Firhouse or Old Bawn, where much development has been planned, there is not a primary care centre to be seen, despite a population of thousands. The population feeds into the university hospital in Tallaght and, as a result, the hospital is bursting at the seams.

My statement on the issue mirrors those of some of my colleagues. I appreciate that the Minister of State is doing his best. The debate provides him with an opportunity to return to his Cabinet colleagues and say that Deputies raised many important issues in the House. The Minister of State referred to money. It is his responsibility to secure that money, while it is mine to hold him to account if he does not do so or if he does not provide the facilities my constituents need. That is why I was elected. I look forward to the Minister of State's response.

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